Provider Demographics
NPI:1649488545
Name:KAVALI, ASHA (MD)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:KAVALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHA
Other - Middle Name:
Other - Last Name:JAYASWAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1160D PITTSFORD VICTOR RD FL 2
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6237
Practice Address - Country:US
Practice Address - Phone:559-734-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231290174400000X
IDM-104832085R0202X
NY231290-12085R0202X
CAC543282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649488545Medicaid
ID808196200Medicaid
NY02621805Medicaid
NY02621805Medicaid
GA202I302429Medicare PIN